Determining Optimal Cut-Off Value of Pancreatic-Cancer-Induced Total Cholesterol and Obesity-Related Factors for Developing Exercise Intervention: Big Data Analysis of National Health Insurance Sharing Service Data

Abstract

This study aimed to examine the effects of multiple parameters on the incidence of pancreatic cancer. We analyzed data from 1,108,369 individuals in the National Health Insurance Sharing Service Database (NHISS DB; birth to death; 2002 to 2015) and identified 2912 patients with pancreatic cancer. Body mass index, systolic/diastolic blood pressure, and fasting blood glucose and total cholesterol concentrations were lower in women with than without pancreatic cancer (p < 0.01). Fasting blood glucose and total cholesterol concentrations were significantly different between men with and without pancreatic cancer (p < 0.05). In the logistic regression analysis, the total cholesterol concentration (odds ratio (OR), 1.007; 95% confidence interval (CI), 1.005-1.010) was significantly higher in men than women with pancreatic cancer (p < 0.05). Pancreatic cancer rates were highest in men who smoked for 5-9 years or more (OR, 5.332) and in women who smoked for 10-19 years (OR, 18.330). Daily intensive exercise reduced the risk of pancreatic cancer by 56% in men (95% CI, 0.230-0.896). Receiver operating characteristic curve analysis revealed a total cholesterol concentration cut-off point of 188.50 mg/dL (p < 0.05) in men with pancreatic cancer, with a sensitivity and specificity of 53.5% and 54.6%, respectively. For women, the cut-off values for weight and gamma glutamyl transpeptidase concentration were 58.5 kg and 20.50 U/L, respectively. The sex-specific differences in patients with pancreatic cancer identified herein will aid in the development of individualized evidence-based prognostic and preventive programs for the treatment of pancreatic cancer.

Keywords: National Health Insurance Sharing Service Database; big data analysis; obesity; pancreatic cancer; prevention program development.

Figure 1

Data from 2912 patients with pancreatic cancer extracted from 1,108,369 patients registered in the NHISS DB and classified using KSCDCD codes (C25, C25.1, C25.2, C25.4, C25.7, C25.8, C25.9, D01.70, M8150, and M8154). Student’s t-tests, logistic regression, and receiver operating characteristic curve analyses were used to analyze sex-specific differences between cancer and non-cancer groups. NHISS DB, National Health Insurance Sharing Service Database; KSCDCD, Korean Standard Classification of Diseases and Causes of Death. SMK, smoking period in the past (1, 5–9 years; 2, 10–19 years; 3, 20–29 years; and 4, over 30 years); EXERCI, number of days of exercise (1, 1–2 times a week; 2, 3–4 times a week; 3, 5–6 times a week; and 4, almost every day); HT, height (cm); WT, weight (kg); BMI, body mass index (kg/m²); SBP, systolic blood pressure (mmHg); DBP, diastolic blood pressure (mmHg); URIPRO, protein in urine (1, weakly positive; 2, positive [+1]; 3, positive [+2]; 4, positive [+3]; and 5, positive [+4]); HMG level, hemoglobin level (g/dL); FBS, fasting blood sugar concentration (mg/dL); TC, total cholesterol concentration (mg/dL); SGOT, serum glutamic oxaloacetic transaminase and aspartate aminotransferase concentration (U/L); SGPT, serum glutamic pyruvic transaminase and alanine aminotransaminase concentrations (U/L); GTP, gamma glutamyl transpeptidase concentration (U/L); INDIHIS, individual disease history (1, tuberculosis; 2, hepatitis; 3, hepatism; 4, high blood pressure; 5, cardiopathy; 6, cerebral apoplexy; 7, diabetes; 8, cancer; and 9, others); FAMHIS, familial disease history (1, hepatism; 2, high blood pressure; 3, cerebral apoplexy; 4, cardiopathy; 5, diabetes; 6, cancer or others); VPA, number of days undertaking 20 min of intensive exercise in a week (1, 1 d; 2, 2 d; 3, 3 d; 4, 4 d; 5, 5 d; 6, 6 d; and 7, 7 d); MPA, number of days undertaking 30 min of moderate exercise in a week (1, 1 d; 2, 2 d; 3, 3 d; 4, 4 d; 5, 5 d; 6, 6 d; and 7, 7 d); LPA, number of days undertaking ≥ 30 min of walking in a week (1, 1 d; 2, 2 d; 3, 3 d; 4, 4 d; 5, 5 d; 6, 6 d; and 7, 7 d); SICK, sickness symptom; CANCERHIS, individual disease history (1, tuberculosis; 2, hepatitis; 3, hepatism; 4, high blood pressure; 5, cardiopathy; 6, cerebral apoplexy; 7, diabetes; 8, cancer; and 9, others); and AGE, age (years).

Figure 2

Graph of the ROC curve utilized in pancreatic cancer analysis. The AUC values for women (height, weight, and GTP concentration) and men (TC concentration) were 0.837, 0.693, 0.602, and 0.575, respectively, with cut-off values of 165.50 cm, 58.50 kg, 20.50 U/L, and 188.50 mg/dL, respectively. ROC, receiver operating characteristic; AUC, area under the curve; GTP, gamma glutamyl transpeptidase; TC, total cholesterol.